A systematic review of nurse‐led weaning protocol for mechanically ventilated adult patients

ABSTRACT Objectives The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician‐led care. Background Protocol‐directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients. Study design Systematic review with meta‐analysis. Search strategy The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. Inclusion and exclusion criteria Searches were performed to identify the best available evidence including quantitative studies of nurse‐led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non‐nurses and non‐invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. Results The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse‐led weaning protocol for reducing the duration of mechanical ventilation (mean differences = −1.69 days, 95% confidence interval = −3.23 to 0.16), intensive care unit length of stay (mean differences = −2.04 days, 95% confidence interval = −2.57 to −1.52, I 2 = 18%, and p = 0.00001); and hospital length of stay (mean differences = −2.9 days, 95% confidence interval = −4.24 to −1.56, I 2 = 0%, and p = 0.00001). Conclusion There is evidence that the use of nurse‐led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. Relevance to clinical practice This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.